Gap cover is basically top-up insurance for your medical aid. It bridges the gap between medical expenses and what your medical scheme covers.

How does gap cover work?

Medical aids set an annual rate that is paid to specialists for every procedure. Based on your medical aid option, you can be covered for up to 300% of the medical aid rate.

Specialists usually charge more than what your medical aid covers, causing a shortfall between their rate and what your medical aid covers.

This is when gap cover kicks in, protecting you against unexpected expenses.

Why do I need gap cover?

• Specialists often charge more than the amount covered by your medical aid
• The hospitals and specialists you want to use may fall outside of your medical aid network
• You could reach the limit of your medical aid’s benefits
• Hospitals can also charge co-payments for certain procedures

Without gap cover, you’ll have to pay for these expenses out of your own pocket.

what exactly does gap cover,cover?

In-Hospital Specialist fees.

This covers Specialist shortfalls for any approved admission in a hospital or day clinic. 

Upfront Co-payments.

Covers against upfront co-payments for certain procedures.

 Cover in emergency departments.

Receive emergency medical treatment for injuries and illness beyond the cover of your medical aid.

Out of office Specialist shortfalls.

Medical specialist shortfalls will be covered for consultations and treatment when non admittance to hospital. 

Day to Day medical costs.

Cover for specialist consultations if referred to by your GP, including pathology and radiology.

Extended Maternity benefits.

​Protection against maternity costs beyond medical aid limits.